Plant and soil biodiversity can have significant effects on herbivore resistance mediated by plant metabolites. Here, we disentangled the independent effects of plant diversity and soil legacy on constitutive and herbivore-induced plant metabolomes of three plant species in two complementary microcosm experiments. First, we grew plants in sterile soil with three different plant diversity levels. Second, single plant species were grown on soil with different plant diversity-induced soil legacies. We infested a subset of all plants with Spodoptera exigua larvae, a generalist leaf-chewing herbivore, and assessed foliar and root metabolomes. Neither plant diversity nor soil legacy had significant effects on overall foliar, root, or herbivore-induced metabolome composition. Herbivore-induced metabolomes, however, differed from those of control plants. We also detected 139 significantly regulated metabolites by comparing plants grown in monocultures with conspecifics growing in plant or soil legacy mixtures. Moreover, plant-plant and plant-soil interactions regulated 141 metabolites in herbivore-induced plants. Taken together, plant diversity and soil legacy independently alter the concentration and induction of plant metabolites, thus affecting the plant's defensive capability. This is a first step towards disentangling plant and soil biodiversity effects on herbivore resistance, thereby improving our understanding of the mechanisms that govern ecosystem functioning.

Introduction Vascular access is required for most cardiac electrophysiology procedures. Over the past two decades, ultrasound guidance has increased in utilization as the primary method for assisting operators in gaining access for cardiac implantable electronic device (CIED) implantation. Methods Ultrasound guidance using a technique that includes both short-axis and long-axis views combined with a twisting needle motion after maximal tenting provides an extremely safe and reproducible technique for vascular access for all CIED procedures. Results and Conclusions In this manuscript and accompanying videos, the author will provide a step-by-step guide for optimal ultrasound guided visualization and needle maneuver technique to maximize safety and efficiency for vascular access in all CIED procedures.

Typhoid fever is transmitted by ingestion of polluted water, contaminated food, and stool of typhoid-infected individuals, mostly in developing countries with poor hygienic environments. To find novel therapeutic targets and inhibitors, the complete genomes of eight Salmonella Typhi strains were primarily subjected to the EDGAR tool to predict the core genome (n=3207). Human non-homology (n=2450) was followed by essential genes identification (n=37). The STRING database predicted maximum protein-protein interactions, followed by cellular localization. The virulent/immunogenic ability of predicted genes were checked to differentiate drug and vaccine targets. Furthermore, the 3D models of the identified putative proteins encoded by the respective genes were constructed and subjected to druggability analyses where only “highly druggable” proteins were selected for molecular docking and simulation analyses. The putative targets include ATP-dependent CLP protease proteolytic subunit, Imidazole glycerol phosphate synthase hisH, 7,8-dihydropteroate synthase folP and 2,3-bisphosphoglycerate-independent phosphoglycerate mutase gpmI. A ZINC drug-like library (n=12000) was screened against each identified targets and top hits were selected based on H-bonds, RMSD and energy scores. Finally, the ADMET properties for novel inhibitors ZINC19340748, ZINC09319798, ZINC00494142, ZINC32918650 were optimized followed by binding free energy (MM/PBSA) calculation for ligand-receptor complexes. The findings of this work are expected to aid in expediting the identification of novel protein targets and inhibitors in combating typhoid Salmonellosis, in addition to the already existing therapies.

Mounting evidence suggests that rapid evolutionary adaptation may rescue some organisms from the impacts of ongoing climate change. However, evolutionary constraints might hinder this process, especially when different aspects of environmental change generate antagonistic selection on genetically correlated traits. Here, we use individual-based simulations to explore how genetic correlations underlying the thermal physiology of ectotherms might influence their responses to the two major concomitant components of climate change---increases in mean temperature and thermal variability. We found that genetic correlations can influence population dynamics under climate change, with declines in population size varying three-fold depending on the type of correlation present. Surprisingly, populations whose thermal performance curves were constrained by genetic correlations often declined less rapidly than unconstrained populations. Our results suggest that accurate forecasts of the impact of climate change on ectotherms will require an understanding of the genetic architecture of the traits under selection.

Compare with transient expression, stable cell lines generally have higher productivity and better quality for protein expression. However, selection of stable cell line is time-consuming and laborious. Here we describe an optimized selection method to achieve high-efficient stable cell pools with Expi293F suspension cells. This method only takes two to three weeks to generate stable cell pools with 2- to 10-fold higher productivity than transient gene expression (TGE). In fed-batch culture with Yeastolate, > 1 g/L yield was achieved with our KTN0239-IgG stable cell pool in shaker flasks. This method can be also applied to efficiently display proteins on the cell surface.

Background and Aims: Finerenone, a nonsteroidal MR antagonist (MRA), enhances renal and cardiovascular outcomes in patients with type 2 diabetes (T2DM). Finerenone’s safety and effectiveness in renal function are debatable. This meta-analysis evaluates the efficacy and safety of treatments for patients with diabetic kidney disease.Methods: To find relevant RCTs, the databases PubMed, Embase, and Google Scholar were searched. Finerenone’s effects were quantified using estimated pooled mean differences (MDs) and relative risks with 95% confidence intervals (CIs).Results: This meta-analysis combines seven double-blind trials involving patients with CKD and type 2 diabetes who were randomly assigned to finerenone or placebo. The primary efficacy time-to-event outcomes were cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalization, kidney failure, a sustained 57% decrease in estimated glomerular filtration rate from baseline over 4 weeks, or renal death. In this meta-analysis of 39,995 patients, treatment with Finerenone was associated with a lower risk of death due to cardiovascular and renal outcomes than placebo (RR = 0.86 [0.80, 0.93] p=0.0002; I2= 0%) and (RR = 0.56 [0.17, 1.82] p=0.34; I2= 0%), respectively. Finerenone treatment was also associated with a marginally lower risk of serious adverse events (RR = 0.95 [0.92, 0.97] p 0.0001; I2= 0%), but no overall difference in the risk of adverse events was found between the two groups (RR = 1.00 [0.99, 1.01] p=0.56; I2= 0%).Conclusion: The administration of finerenone decreases the likelihood of end-stage kidney disease, renal failure, cardiovascular death, and hospitalization. Therefore, we propose that patients with T2DM and CKD undergo finerenone therapy.Keywords: Diabetes, Chronic kidney disease, CKD, Cardiovascular disease, Finerenone, Non-steroidal Mineralocorticoid receptor antagonist, Meta-analysis.

This study aims to reduce the mutual coupling and envelope correlation coefficient (ECC) parameters of massive MIMO antennas. This parameter is important to support the performance of MIMO antennas in increasing high-speed data transmission. The observation of this study was carried out at the C-Band 3.5 GHz frequency as one of the 5G frequency bands under 6 GHz. The study used a massive MIMO 64 element antenna design with the addition of a specially designed Uni-planar Compact EBG (UC-EBG) surrounding the antenna element. Simulation and measurement results are compared with conventional MIMO antenna performance (without UC-EBG). Simulation results and antenna measurements show that the addition of the UC-EBG structure has succeeded in reducing the mutual coupling by 1.23 dB and improve the ECC parameter by 0.61. In addition, the UC-EBG structure can improve the performance of return loss and massive MIMO antenna VSWR

Background and Purpose Vibrio vulnificus (V. vulnificus), a gram-negative bacterium, causes serious wound infections and septicemia. Once it develops into early-phase sepsis, hyperinflammatory immune responses result in poor prognosis in patients. The present study aimed to examine the possible underlying pathogenic mechanism and explore potential agents that could protect against V. vulnificus cytotoxicity. Experimental Approach The anti-pyroptotic effects of P2X7 receptor (P2X7R) antagonists were assessed in an experimental murine V vulnificus infection. In vitro, the effects of P2X7R antagonists on V vulnificus-induced anti-phagocytosis and pyroptosis in murine macrophages were examined. Key Results Here, we report that infection of mouse macrophages with V. vulnificus triggers anti-phagocytic effects and pyroptotic inflammation via ATP-mediated purinergic P2X7R signaling. V. vulnificus promoted P2X7-dependent NF-κB p65 translocation, modulating the expression of the inflammasome sensor NLRP3, adaptor ASC, and pyroptotic protein gasdermin D (GSDMD) in mouse macrophages. V. vulnificus induced the NLRP3/caspase-1 inflammasome signaling complex expression that drives GSDMD transmembrane pore formation and secretion of IL-1β, IL-18, and MIP-2. This effect was blocked by P2X7R antagonists, indicating that the P2X7R mediates GSDMD-related pyroptotic inflammation in macrophages through the NF-κB/NLRP3/caspase-1 signaling pathway. Furthermore, blockade of P2X7R reduced V. vulnificus-colony-forming units in the spleen, immune cell infiltration into the skin and lung tissues, and serum concentrations of IL-1β, IL-18, and MIP-2 in mice. Conclusions and Implications These results indicate that P2X7R plays a vital role in mediating phagocytosis by macrophages and pyroptotic inflammation during V. vulnificus infection and provides new opportunities for therapeutic intervention in bacterial infections.

Fretting fatigue experiments were conducted on a modified 9Cr-1Mo (P91) steel under flat-on-flat contact with maximum applied cyclic stress (σ max) levels of 450 MPa, 500 MPa and 550 MPa at a stress ratio of 0.3 and a contact pressure of 100 MPa. A decrease in the cyclic life was observed with increase in σ max. Chaboche model with isotropic and kinematic hardening was employed in finite element analysis to evaluate the stress distribution near the contact pad and along contact surface under fretting fatigue conditions. In addition, the contact-related parameters such as contact pressure, contact shear stress and relative tangential motion were also assessed. The relative tangential motion was found to increase with increasing σ max. Besides, the peak values of normal stress (parallel to applied loading direction) and maximum principal stress were observed around the leading and trailing edges of the contact pad at the σ max. The amplitude of relative tangential motion as well as slip zone increases with σ max. The orientations of the principal plane and shear plane to the applied cyclic loading direction are -89.5 ̵̊ and -134.5 ̵̊, irrespective of the σ max. The fracture surface of the failed specimen revealed that the direction of the crack was nearly perpendicular to the applied stress. Smith-Watson-Topper parameter was used for estimating the crack initiation life with σ max. It has been noticed that the fraction and dominance of crack initiation or propagation phase depend on the imposed cyclic condition for the steel.

Background: Qilong capsule (QLC) is a traditional Chinese medicine commonly used to treat ischemic stroke (IS). But the pharmacodynamic mechanism of QLC is not clear. Method: we used an existing zebrafish model to explore the protective mechanism of QLC on IS. We treated normally-developing zebrafish larvae with QLC and ponatinib 2 days post fertilization, and used the area of cerebral vascular thrombosis, red blood cell staining intensity, and brain cell apoptosis to quantitate QLC efficacy against IS. Real-time quantitative polymerase chain reaction (qPCR) was used to detect changes in the expression of genes involved in coagulation, inflammation, vascular endothelium, and apoptosis. Result: We found that QLC reduced the area affected by ponatinib-induced cerebral vascular embolism, erythrocyte staining intensity, and the number of apoptotic brain cells. qPCR showed that QLC inhibited the expression of genes related to coagulation, inflammation, and apoptosis. Conclusion: QLC had a significant protective efficacy in ponatinib-induced IS.

Immunological Thrombocytopenic Purpura or ITP is the most common benign blood disease in pediatrics. The aim of this work is to analyze the epidemiological, clinical, paraclinical and etiological profile of Primary and secondary immune thrombocytopenia. It is a retrospective study over a period of four years from September 2017 to September 2021, collecting all cases of immunological thrombocytopenic purpura hospitalized in hematology pediatric unit at the Abderrahim Harouchi Children’s Hospital in Casablanca. 135 patients with ITP were hospitalized in this period including 76 boys (56.3%) and 59 girls (43.7%). The average age was 5.8 years (1 month -14 years). According to Buchanan bleeding score, 3.4% of the patients were grade 0, 9.6%, were grade 1 and 39.2% of the patients were grade 2, 41.5 % of the patients were grade 3, 5% in grade 4 and only 1 case was in grade 5. Etiologically, 86% of primary ITP and 14% of secondary ITP were recorded. The etiological assessment revealed 9 cases of Helicobacter pilori infection, 6 cases of immune deficiency (5 cases of WISKOTT ALDRICH and 1 case of ALPS) and4 probable cases of systemic lupus erythematosus. Patients were treated with either corticosteroids or intravenous immunoglobulin (IgIV). The trend was towards acute ITP in 85 cases (63%), persistent and chronic ITP in 50 cases (37%). For a better management of chronic and persistent ITP a complete etiological assessment is essential. This will allow to propose an etiological treatment and therefore an improvement of thrombocytopenia.

IntroductionSince the initial attempts to treat children with renal cancer over 50 years ago, outcome for children with renal cancer has generally become promising. While the first endeavors mainly included surgical treatment, in the early 60s radiotherapy and chemotherapy were introduced, leading to cure of patients, including some with metastatic disease. (1) Since then, overall survival rates for the most common type of renal tumors in childhood (nephroblastoma or Wilms tumor) have improved to more than 90 percent. These excellent treatment outcomes are similar in the 2 largest clinical trial groups (the Children’s Oncology Group Renal Tumor Committee (COG-RTC; former National Wilms Tumor Study Group (NTWSG)), and the International Society of Pediatric Oncology Renal Tumor Study Group (SIOP-RTSG). Despite the difference in upfront treatment choice (primary surgery when feasible (COG-RTC) or preoperative chemotherapy (SIOP-RTSG)) both groups have optimized the stratification of patients in their trials by modifying the intensity of treatment according to individual risk factors, in order to improve outcome for high-risk renal tumor types, but also to reduce early and late toxicity in lower and intermediate risk tumors as much as possible. (2-4)This improvement in risk stratification has resulted in better outcomes and less cancer related toxicity. However, for remaining small subgroups of pediatric renal tumor patients, with very poor outcomes, further understanding of the underlying biology, in correlation with clinic-pathological characteristics, is an unmet need. Further, standard multidisciplinary treatment (surgery, radiotherapy, chemotherapy) can be challenging to access and/or deliver in some low and middle income countries (LMIC). The power inherent in international collaboration to address these challenges was a driving principle that supported the creation of the HARMONICA (HARMONIzation and COllaboration) initiative in 2015, when we established an organized collaborative structure for transatlantic experts from COG-RTC and SIOP-RTSG. The mandate of HARMONICA is to identify specific challenges for pediatric renal tumor subsets in order to meet the aims of our global approach to cure every child with a renal tumor with limited toxicity.The HARMONICA group meets at least once a month by videoconferences, and as much as possible also face to face, at least once or twice a year, during existing pediatric cancer conferences. In addition, several transatlantic HARMONICA expert subgroups are collaborating on specific topics. All work is currently done by a tremendous engagement of many enthusiastic members of both study groups. Despite the fact of obvious advantages, HARMONICA is still lacking funding and needs to optimize their structure as a legal entity. Notwithstanding such limitations, in this special issue of PBC, we present the achievements, the challenges, and the future perspectives, identified by these expert groups.

1. Describing and explaining patterns of individual animal behaviors in situ, and their repeatability over the annual cycle, is an emerging field in ecology owing largely to advances in tagging technology. 2. We describe individual movements of adult Sakhalin taimen Parahucho perryi, an endangered salmonid fish, in the headwaters of a river in northern Japan during the spring spawning season over two years. 3. Migration timing, separated into stages prior to, during, and following the spawning period, was found to be more consistent and repeatable for females than males. 4. We hypothesized that the observed coordinated movement within seasons, and repeatability in migration timing across seasons, could result from 1) individual-specific responsiveness resulting from endogenous, biological traits that are mediated by environmental factors, or 2) social interactions among comigrating individuals. 5. We found that water temperature and water level experienced by fish near the river mouth approximately a week before arrival at the spawning ground explained variability in run timing between years for females but not males. 6. We found no evidence of conspecific attraction or repulsion resulting from social interactions among the spawners and post-spawners. 7. We conclude that individual-specific responsiveness to environmental cues was the likely mechanism underpinning the observed migration timing and movement patterns. 8. Determining the importance of these environmental and social factors not only during spawning but also during non-breeding life-history stages would contribute to a more comprehensive understanding of migratory connectivity in this species.

Cases of bullous pemphigoid following Covid-19 vaccines have been recently reported. We describe herein an atypical case of acral bullous pemphigoid after Pfizer BionTech vaccine. Clinicians should be aware of this reaction and encourage full vaccination as the disease displays a rapid improvement treatment.

Background: Electrocardiographic left ventricular hypertrophy (ECG LVH) has a prognostic value for cardiovascular diseases. Pathological processes that cause development of left ventricular hypertrophy (LVH) also leads to remodeling and dysfunction of the left atrium (LA). Atrial functions can be evaluated by 2D speckle tracking echocardiography. In our study, we aimed to investigate whether the ECG LVH is associated with left atrial strain. Methods: Sixty two patients with LVH according to echocardiographic left ventricle mass index were included in the study. ECG LVH was defined according to: Sokolow- Lyon voltage SV1+RV5/RV6>35mm; Cornell voltage RaVL+SV3>28 mm (for men) >20mm (for women); or Cornell product (SV3+RAVL+(for women 8 mm)) x QRS duration)>2440 mmxms criteria. Patients were categorised into two groups according to presence or absence of ECG LVH. Association between left atrial strain values and ECG findings were evaluated. Results: The mean age of the patients were 58.3±10.1 years; 40.3% were women; 91,9% had hypertension; 35.5% had diabetes. Nineteen patients (30.6%) had ECG LVH according to Sokolow-Lyon voltage, Cornell voltage or Cornell product. Left atrial reservoir, conduit and contraction strains were significantly lower in patients with ECG LVH (p<0.001). Additionally, there was statistically significant correlation between all three phases of left atrial strain values and presence of Sokolow-Lyon voltage (reservoir phase r:-0.389 p<0.01; conduit phase, r:-0.273 p<0.05; contraction phase r:-0.359 p<0.01) Cornell voltage (reservoir phase r:-0.49 p<0.001; conduit phase r:-0.432 p<0.001; contraction phase r:-0. 339 p<0.01) Cornell product (reservoir phase r:-0.471 p<0.001; conduit phase r:-0.387 p<0.01; contraction phase r:-0.362 p<0.01). Conclusion: ECG LVH was associated with left atrial strain and therefore it can be a useful tool to predict left atrial dysfunction.

A 54-year old woman with history of hypertension was admitted our hospital with NYHA class 2-3 dyspnea. Fifteen years ago, she had primum atrial septal defect repair, septal myectomy and anterior mitral leaflet repair. Transthoracic echocardiography revealed a 112 mmHg gradient at rest in the left ventricular outflow tract (LVOT), suggesting the subaortic membrane. When transesophageal echocardiography was performed, it was observed that there was no subaortic membrane, but tunnel-type obstruction due to septal bulging in the left ventricular outflow tract. It was understood that this obstruction also contributed to the abnormally located papillary muscle, which is directly connected to the anterior mitral leaflet. The patient was evaluated as partial type Atrioventricular Septal Defect (AVSD) with a history of previous operation, anomaly of the anatomy of LVOT and atrioventricular valves, and other available findings, and the patient underwent mitral valve replacement with septal myectomy. After the operation, the lvot gradient decreased, the symptoms of the patient regressed and the patient was followed up medically.

Most previous treatment guidelines for pregnant women with mechanical heart valves (MHVs) recommended that low molecular weight heparin (LMWH) should be applied once every 12 hours and only as required to reach peak anti-Xa levels of around 1.0–1.2 IU/mL,but it is commonly associated with and subtherapeutic trough levels consequently with an inadequate level of anticoagulation. Our case report here together with a literature review suggests that dose-adjusted (Target trough anti-Xa levels of 0.6-0.7 IU/mL and with peak anti-Xa levels of around 1.0–1.2 IU/mL or less than 1.5 IU/mL) LMWH should be given thrice daily throughout pregnancy.In addition, the findings of this rare case indicate that a combination of LMWH and warfarin is effective in the treatment of small thromboses in pregnancy.

Auxotrophic marker genes have widely used for genetic engineering in yeast. However, the effects of auxotrophic strains that are deficient in synthesis of amino acids or nucleotides on the growth and production are rarely reported. In this study, a total of eight auxotrophic strains with single knockout of selective markers were obtained to evaluate cell growth and free fatty acid (FFA) production in Saccharomyces cerevisiae with supplementing different concentrations of amino acids or nucleotides. Generally, except for gene ADE2, most auxotrophic strains possessed decreased cell growth and FFA production, which could be remedied by the higher concentrations of supplements. leu2Δ damaged both growth and production even with supplementation of 1000 mg/L leucine. Therefore, this study shows that auxotrophs compromise the metabolic engineering endeavor and provides a guidance in supplementing amino acids or nucleotides during fermentations for maximizing bio-productions.

As a new type of energy structure, marine power generation has become the main direction of future energy. Wave-energy magnetohydrodynamic power generation technology is widely used in the development of marine energy. To study the factors influencing the zero-load voltage of a novel piston-type magnetohydrodynamic (MHD) ocean power generation device, a three-dimensional flow model was developed for the power generation device. Because a Hartmann layer existed in the rectangular power generation channel, the internal structure of the power generation channel was improved by changing the traditional rectangular power generation channel to a piston-pipe channel. According to Faraday’s law and the hydrodynamic theory, the MHD module in CFD software was used conduct finite-element simulations of the generation device. The influences of the inlet velocity, the velocity distribution, and the current density on the zero-load voltage were investigated. The results showed that for regular wave motion, the zero-load voltage was positively proportional to the inlet velocity and the channel width. After the channel was improved, the optimal zero-load voltage and the minimum relative error were obtained when the inlet velocity was 3 m/s and the channel width was 60 mm.

Myriad ecological and evolutionary factors can influence whether a particular parasite successfully transmits to a new host during a disease outbreak, with consequences for the structure and diversity of parasite populations. However, even though the diversity and evolution of parasite populations is of clear fundamental and applied importance, we have surprisingly few studies that track how genetic structure of parasites changes during naturally occurring outbreaks in non-human populations. Here, we used population genetic approaches to reveal how genotypes of a bacterial parasite, Pasteuria ramosa, change over time, focusing on how infecting P. ramosa genotypes change during the course of epidemics in Daphnia populations in two lakes. We found evidence for genetic change – and, therefore, evolution – of the parasite during outbreaks. In one lake, P. ramosa genotypes structured by sampling date; in both lakes, genetic distance between groups of P. ramosa isolates increased with time between sampling. Diversity in parasite populations remained constant over epidemics, though one epidemic (which was large) had low genetic diversity while the other epidemic (which was small) had high genetic diversity. Our findings demonstrate that patterns of parasite evolution differ between outbreaks; future studies exploring the feedbacks between epidemic size, host diversity, and parasite genetic diversity would improve our understanding of parasite dynamics and evolution.

Water sources carry chemicals that can have a significant impact on the water environment of a river network, and understanding the contribution of different water sources to the river network can help to manage the pollution of the river network at its source. Hydrological connectivity of a river network affects the self-purification capacity and flood prevention capacity of the river. Thus an isotope tracer approach was applied to figure out the contribution rate of different water bodies to a river network and hydrological connectivity was quantified by introducing retention rate. Changzhou city was selected as the study area because it is an urbanized city with the characteristics of plain river network and it is faced with poor hydrological connectivity due to artificial constructions (dams and pumps) and human activity (urbanization). River water, well water (shallow groundwater), lake water and rainfall were collected during the flood season and nonflood season, and hydrogen and oxygen isotopes were determined. The temporal and spatial variations in hydrogen and oxygen isotopes in different water bodies and the state of the water cycle in different water bodies were analyzed. IsoSource and MixSIAR models were established to analyze the contribution rate of river network water sources in the study area, and their effectiveness was compared. Results of MixSIAR model were selected to evaluate the hydrological connectivity of the river network in the study area, providing a method to quantify the hydrological connectivity of specific river of the river network in Changzhou. This method could also be applied to other urban plain river network area to study its river connectivity.

Background: Contact force has been used to titrate lesion formation for radiofrequency ablation. Pulsed Field Ablation (PFA) is a field-based ablation technology for which limited evidence on the impact of contact force on lesion size is available. Methods: Porcine hearts (n=6) were perfused using a modified Langendorff set-up. A prototype focal PFA catheter attached to a force gauge was held perpendicular to the epicardium and lowered until contact was made. Contact force was recorded during each PFA delivery. Matured lesions were cross-sectioned, stained, and the lesion dimensions were measured. Numerical modeling of the catheter-tissue interface under different contact forces was performed to aid in the interpretation of our results and isolate effects of biomechanical tissue displacement. Results: A total of 82 lesions were evaluated with contact forces between 1.3 g and 48.6 g. Mean lesion depth was 4.8 ± 0.9 mm (standard deviation), mean lesion width was 9.1 ± 1.3 mm and mean lesion volume was 217.0. ± 96.6 mm 3. Linear regression curves showed an increase of only 0.01 mm in depth (Depth = 0.01*Contact Force + 4.37, R 2 = 0.06), 0.03 mm in width (Width = 0.03*Contact Force + 8.32, R 2 = 0.12) for each additional gram of contact force, and 2.20 mm 3 in volume (Volume = 2.20*Contact Force + 163, R 2 = 0.11). Numerical modeling found consistent trends with experimental mean values and shows tissue displacement alone is likely not a significant factor to formation of lesion depth. Conclusions: Increasing contact force using a bipolar, biphasic focal PFA system has minor effects on acute lesion dimensions in an isolated porcine heart model.

Background: The dizygotic monochorionic twins complicated with twin-twin transfusion syndrome were thought as rare events. Objective: To report a case of twin-twin transfusion syndrome in a dizygotic monochorionic diamniotic twin that was successfully treated using fetoscopic laser photocoagulation, as well as to review the published literature on dizygotic monochorionic twins with twin-twin transfusion syndrome. Search Strategy: Combinations of “dizygotic monochorionic” “twin-twin transfusion syndrome” were used as keywords with search engine PubMed. Articles were reviewed for year of publication and extraction and analysis of the same data. Selection Criteria: Cases of twin-twin transfusion syndrome in a dizygotic monochorionic diamniotic twin gestation treated using fetoscopic laser photocoagulation were included. Data Collection and Analysis: Basic characteristics and outcome of dizygotic monochorionic diamniotic twins were collected and analyzed. Main results: The pregnancy woman delivered vaginally at 32+3 weeks of gestation due to premature rupture of membrane. Both babies had normal-appearing external genitalia. The literature identified 39 dizygotic monochorionic twins and 8 (20%) of the 40 cases (including the current case) complicated by twin-twin transfusion syndrome. Four cases undergoing laser therapy and three cases resulted in live births. Conclusions: The possibility of dizygotic twins should be considered when encountering monochorionic twin pregnancies with different fetal sex. Fetoscopic laser surgery could be used in dizygotic monochorionic twin pregnancy with twin-twin transfusion syndrome.

A general misconception that unicuspid aortic valves (UAV) are just a subtype of bicuspid aortic valves (BAV) has now been perpetuated in the medical and surgical community for nearly two decades[1](#ref-0001), and there is no end in sight.